Question 1 of 10

In this MRCS Part B scenario you are the surgical registrar. The anaesthetist for today’s list has some questions for you.

Here is today's list.

As you can see, the first patient on the list has a cardiac pacemaker.

What difficulties can this pose for the theatre team?

Pacemakers can pose problems both the surgeon and the anaesthetist.

The surgeon must be careful with use of diathermy, so ensure it doesn’t interfere with the pacing function.

The anaesthetist must ensure that monitoring is appropriate, and that there is equipment available to deal with the consequences of a failure of the pacing device.

Theatre staff should ensure correct positioning of the patient electrode, so that any current that passes between a diathermy device and the patient does not pass near the pacemaker.

The use of diathermy in the context of a pacemaker will also depend on the type of pacemaker e.g. Diathermy is contraindicated in a patient with an ICD (implantable cardioverter defibrillator).